Dr. Eibling said he thinks training on how to handle situations like this will become more common. “This is going to become a greater part of what we all do with our trainees, is help them in rehearsing and practicing this kind of decision-making,” he said.
Explore This IssueMarch 2013
Case 3: Radiesse Injection
Dr. Sataloff discussed the case of a 52-year-old man with dysphonia whose symptoms made him “functionally elderly.” He had developed a weak voice 10 years prior to this, and a laryngoscopy had found bowing and glottic insufficiency. Three Radiesse injections into the vocal fold, given by another doctor, had brought “somewhat satisfactory” results. A fourth injection had made his symptoms worse, however. Video footage showed the left fold not pliable and moving as a block.
When Dr. Sataloff saw the man, he debulked the Radiesse, which is easier to do than with Teflon, because Radiesse resorbs over time. Most of the Radiesse can be removed, while the remnants will eventually disappear. The patient ended up with glottic insufficiency again, so Dr. Sataloff waited a year and then did a bilateral thyroplasty. The man now has better glottic closure and no longer has to exert himself so much to use his voice.
Dr. Sataloff said it’s a cautionary tale about Radiesse. “Overinjection is a real problem,” he said. “Although hydroxylapatite is much like bone and is supposed to be nonreactive and usually is fine, there are a small number of patients who develop histopathology and clinical pathology that is indistinguishable from a Teflon granuloma.”